title: Single-stage repair of the anterior chest wall following sternal destruction complicated by mediastinitis.
abstract: OBJECTIVE
  Although various techniques have been described, the ideal reconstructive procedure for treating massive sternal fragmentation and necrosis is still a matter of debate. Sometimes, reconstruction is so challenging that repetitive operations are required, particularly when complicated by mediastinitis and sternal osteomyelitis.
  
  
  METHODS
  Five patients (three males, two females, median age 66) with severe osteomyelitis and sternal destruction after receiving myocardial revascularization underwent partial or radical sternal resection, omental flap transposition, titanium mesh implantation and rectus abdominis muscle flap transposition. The final procedure involved single-stage closure.
  
  
  RESULTS
  One patient died 9 days after the final procedure due to pneumonia and septicemia. The other patients received antibiotics for at least 6 weeks postoperatively. The mean hospital stay was 36 days. Optimal wound healing was observed, with acceptable cosmetic disorders.
  
  
  CONCLUSIONS
  Although lateral sternal support is the first-line surgical treatment for sternal dehiscence, performing primary closure of complicated defects is often impossible. Aggressive treatment modalities are required in such cases for anterior chest wall defects. This technique provides the ability to perform rigid and stable sternal closure in complicated cases.
authors.affiliation: Department of Cardiovascular Surgery, Faculty of Medicine, Gazi University, Besevler, 06500, Ankara, Turkey, mhzor76@gmail.com.
authors.forename: Mustafa Hakan
authors.initials: MH
authors.lastname: Zor
authors.forename: Mehmet
authors.initials: M
authors.lastname: Acipayam
authors.forename: Huseyin
authors.initials: H
authors.lastname: Bayram
authors.forename: Levent
authors.initials: L
authors.lastname: Oktar
authors.forename: Mustafa
authors.initials: M
authors.lastname: Erdogan
authors.forename: Osman Tansel
authors.initials: OT
authors.lastname: Darcin
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008480:Mediastinitis / Q000601:surgery*; D008875:Middle Aged; D009204:Myocardial Revascularization; D010019:Osteomyelitis / Q000601:surgery*; D011183:Postoperative Complications / Q000601:surgery*; D012086:Reoperation; D013249:Sternum / Q000601:surgery*; D013524:Surgical Flaps; D013526:Surgical Mesh; D019616:Thoracic Surgical Procedures / Q000379:methods*; D035441:Thoracic Wall / Q000601:surgery*; D016896:Treatment Outcome